A scoping review of the use of traditional medicine for the management of ailments in West Africa

Background The coexistence of traditional healing practices deeply rooted in cultural and historical contexts and the evolving landscape of modern healthcare approaches in West African societies creates a dynamic interplay between tradition and modernity in healthcare. This study aims to comprehensively map the landscape of traditional medicine use for health in West Africa. Methods A scoping review was conducted following the Joanna Briggs Institute (JBI) methodology and reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) guidelines. Research questions focused on the links between traditional medicine practices and health in West Africa. The systematic literature search covered PubMed, Web of Science, and CINAHL from database inception to September 2023. A descriptive analysis was conducted highlighting the years of publication, countries of publication, study designs of plant families and plant parts used for making traditional medicines, and the diseases the traditional remedies are for. Results The search identified 3484 records, with 46 articles meeting the inclusion criteria. Publications spanned from 1979 to 2023, with no observed trend in the number of publications over successive decades. Nigeria had the highest number of publications (54.3%), followed by Ghana (19.6%). The studies employed various designs, including clinical trials, ethnobotanical, ethnopharmacological, and experimental designs. Plant families frequently studied included Combretaceae, Euphorbiaceae, and Rubiaceae. Traditional remedies address various health issues, highlighting their versatility, from general symptoms to specific diseases. Conclusion This scoping review offers an extensive overview of traditional healing practices in West Africa. The studies highlighted in this review stress the necessity for culturally sensitive healthcare interventions. The widespread use of traditional medicine and the variety of practices underscore the importance of encouraging collaboration between traditional healers and modern healthcare professionals. This review also identifies knowledge gaps and areas needing further research, setting the stage for future exploration into West Africa’s intricate healthcare landscape.


Introduction
The dynamic interplay between tradition and modernity in healthcare practices remains a complex and intriguing facet of West African societies [1].This interplay reflects the ongoing negotiation between longstanding traditional healing methods deeply rooted in cultural and historical contexts and the evolving landscape of modern healthcare approaches [2].In West Africa, traditional healing practices often involve indigenous knowledge, rituals, and the use of natural remedies passed down through generations [3].These practices coexist with, and at times, intersect with, modern medical interventions, technologies, and pharmaceuticals, thereby reflecting the adaptability and resilience of West African societies in navigating the complexities of health and well-being [4].
Patients often engage with traditional and modern healthcare systems, sometimes concurrently or sequentially, depending on their health needs, personal beliefs, and accessibility [5].This health-seeking behaviors is a common practice across Africa, creating a nuanced healthcare ecosystem in the region [6].This underscores the importance of acknowledging diverse healthcare practices and fostering collaborative efforts between practitioners, including fostering collaborations between traditional healers and modern healthcare professionals [7,8].
As global interest in alternative and complementary medicine grows [9], understanding the prevalence and scope of traditional healing practices in West Africa becomes paramount for fostering culturally sensitive and effective healthcare interventions.Therefore, gathering and synthesizing information is essential to provide a comprehensive overview of traditional healing practices in West Africa.One way of doing this is to identify key themes, patterns, and trends in the literature related to traditional healing practices, thereby allowing for a nuanced understanding of the prevalence and variations of these practices across different regions, communities, and culture contexts in West Africa.By systematically reviewing the existing literature, gaps in knowledge and areas where further research is needed can be identified, and future studies designed.
This scoping review aimed to explore the landscape of traditional medicine use for health in West Africa, a region known for its diverse ethnicities, languages, and cultures and a rich tapestry of indigenous healing practices [10].The review systematically outlines the various modalities employed in traditional medicine and discusses the implications of these findings for public health in West Africa.

Methods
The study design was guided by the Joanna Briggs Institute (JBI) scoping review methodology [11].The study was reported following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews guidelines (PRISMA-ScR) [12,13].

Identifying research question
The review was guided by the research question: What is the extent and nature of English-language publications on utilizing traditional medicine for treating various ailments in West Africa?

Identifying relevant studies
A systematic literature search was conducted in PubMed, Web of Science, and the Cumulative Index of Nursing and Allied Health Literature (CINAHL) using the terms shown in S1 File.The search was conducted from the inception of the database till September 2023.A search of the references of the publications included in the scoping review was also carried out.

Study selection
Publications identified through the search strategy were downloaded into Endnote and imported into Rayyan.After that, duplicate publications were removed.Three researchers (ORA, MTO, MOF) independently screened the titles and abstracts of the downloaded articles using pre-defined inclusion and exclusion criteria.Studies were included if there was an agreement among the three researchers who performed the screening.Disparities were settled by consensus.In addition, the three researchers completed the full-text review (ORA, MTO, MOF).Uncertainty regarding whether publications met the inclusion criteria was resolved via consensus among the three researchers.

Inclusion criteria
Peer-reviewed journal articles that covered traditional medicine and health focusing on West Africa.Studies included were published in the English Language, addressed preventive and curative aspects of traditional medicine, and explored herbal and traditional remedies.Studies reporting outcomes related to the impact of traditional medicine on preventive and curative health were included.There was no restriction on study design or date of publication.

Exclusion criteria
Animal studies were excluded.Also excluded were studies on non-African populations.In addition, unpublished theses and dissertations, letters to the editor, commentaries on studies, scoping, systematic and narrative reviews, and studies whose full lengths could not be accessed were excluded.Also, studies with insufficient results suitable for analysis were excluded.

Data charting process
A data-charting form was developed to extract relevant variables.The charted variables were the literature characteristics (authors, year of publication, country where study was conducted), study aim, study design, form of traditional medicines used, diseases managed, and the outcomes of the studies.

Data analysis
The results of the scoping review were reported according to the PRISMA-ScR checklist.A deductive analysis was conducted using the framework developed for the data extraction.Details generated from the analysis were the years of publication, the country in West Africa where studies were conducted, forms of traditional medicines used, diseases (and diseases pathogenic organisms) investigated, plants (and plant extracts) investigated, and forms and routes of administration of the traditional medicines for the management of diseases.
A descriptive analysis was conducted highlighting the years of publication, countries of publication, study designs, plant families and plant parts used for making traditional medicines, forms in which the traditional remedies are produced, family of plants used for the traditional remedy, and the diseases the traditional remedies are made to prevent or cure.A compilation o of the names of the plant families studied was compiled.The findings were presented in tables.
Fig 2 shows that leaves and roots are the most used for medicinal purposes, followed by barks and stems.Other parts, such as fruits, seeds, and whole plants, also contribute to many plant-based remedies.
As shown in .Forms in which the remedies are administered are gargling, triturate, bathing, enema, fumigant, and shampoo.These remedies can be administered topically, inhaled, orally, intranasally, or using scarification.

Toothaches
The extract yielded four pure compounds that showed antimicrobial activity.One of these compounds is a tertiary phenolic alkaloid (carithine-6-one), and two are quaternary alkaloids (chelerythrine chloride and berberine chloride), while the structure of the fourth compound was not determined.16    The plant family reported in Benin was Combretacea [51].The plant family studied in Mali was Rubiaceae [57].

Discussion
This scoping review maps herbal remedies used for medicinal purposes in humans in West Africa.The findings indicate that the study of traditional medicines has continued and increased over time, thereby underscoring the enduring relevance of traditional medicine research, with contributions consistently observed over the years.There has also been an extensive exploration of medicinal plants across West African countries, including their use for managing various diseases and disorders.The geographic distribution of these studies emphasizes the regional relevance of traditional medicine in addressing diverse health challenges.However, the number of countries in West Africa publishing experimentations on traditional remedies, especially clinical trials and ethnobotanical and ethnopharmacological surveys of plants used for traditional medicine, is low, with research skewed towards Nigeria and Ghana.
One of the strengths of this study lies in its thorough examination of research about traditional medicine used in managing diseases in West Africa-a continent widely recognized for its considerable reliance on traditional healthcare practices for the well-being of its population [63].However, the study had some limitations.First is the inclusion of only publications available and accessible in English, and second is the search limit to three databases employed.These may have inadvertently excluded some research publications on traditional medicines used in West Africa since researchers in the sub-region also publish in French and other languages.Despite this limitation, the present study provides valuable insights into the subject matter.
First, diverse study designs have been employed to investigate traditional medicine in the region.The studies were majorly experimental in design, focusing on laboratory-based investigation of identified traditional remedies.In addition, a few clinical trials, representing systematic investigations on human participants, were conducted to evaluate the safety and efficacy of some traditional medical treatments.There is, however, the need for a lot more experimental and clinical trial studies that can facilitate the translation of the traditional medicines found to have therapeutic effects into commercial products, as the validation of indigenous drugs is relevant to modern societies at large and helps to sustain local health care practices [64].Furthermore, ethnobotanical and ethnopharmacological studies provided insights into plants' traditional knowledge, practices, and uses, contributing valuable cultural context to the exploration.In addition, the ethnobotanical and ethnopharmacological surveys provide a deeper understanding of the traditional knowledge embedded in local communities.The surveys conducted in West Africa spotlighted a diverse array of plant families, plant parts, and preparation methods utilized in traditional remedies.Despite this wealth of knowledge, there remains untapped potential for further exploration using research methods tailored to the practice of traditional medicines [65].
These insights can be enhanced through dedicated studies focusing on specific diseases and their traditional medical remedies, as undertaken by those publications on schistosomiasis [45], cancer [39], sickle cell [14], malaria [22,29,40,50], snake bites [60,61], candidiasis [62], and Herpes simplex virus [46].Conducting disease-centric studies has the potential to aid the sub-region in developing therapeutic measures for disease entities categorized as neglected tropical diseases [66], which are of interest to the sub-region and currently receive limited global attention and funding.Such disease-specific studies on herbal remedies are growing.These include reviews on herbal therapies for diarrhoea in sub-Saharan Africa [67] and the global use of traditional medicines for cancer [68].These disease-specific studies generate evidence for evaluating the efficacy and safety of these herbal remedies, which is crucial for integrating traditional medicine into mainstream healthcare systems to help inform medical decision-making based on empirical data.Further studies are needed to compare the diseasespecific herbal therapies used between regions and their efficacy and safety profile.
The current study highlights the diverse therapeutic applications of identified traditional remedies, encompassing the management of symptomatic conditions and the targeted treatment of specific diseases.However, the efficacies of these therapies remain inadequately studied, with only two identified clinical trials [48,50].To address this gap, countries should actively promote research on traditional medicines by formulating policies and guidelines and funding such endeavors.Developing policies and guidelines that facilitate the seamless integration of traditional medicines into mainstream healthcare can be crucial in encouraging and supporting clinical trials in this field.
Nigeria [69,70] and Ghana [71] are at the forefront of these regional integration efforts.These pioneering initiatives aim to bridge the gap between traditional and modern medical practices and foster a more comprehensive approach to healthcare that embraces the rich heritage of traditional healing methods.The progress made by these nations in the number of publications on traditional medicines reflects a dedicated commitment to exploring the potential benefits of traditional medicine within the broader healthcare framework.As these integration efforts unfold, they promise to expand therapeutic options for patients, foster collaborative healthcare practices, and preserve the invaluable traditional knowledge passed down through generations.There are also ongoing efforts in Sierra Leone, led by the World Health Organisation, to regulate the practice of traditional medicines in the country.The observed regional disparity in the countries contributing information on using plants for traditional medicines emphasizes the need for broader engagement and collaboration to enrich the diversity of perspectives and practices captured in research.
Frequently referenced plant families in medicinal studies in West Africa include Euphorbiaceae, Rubiaceae, Combretaceae, Meliaceae, and Euphorbiaceae, has gained global recognition for their effectiveness in treating gastrointestinal disorders, respiratory complaints, skin problems, and inflammation and injuries [72].Within the Rubiaceae family, plant species predominantly found in warmer climates are indicated for treating diverse conditions such as malaria, hepatitis, eczema, edema, cough, hypertension, diabetes, and sexual dysfunction.Biological screenings of plants used by traditional healers have demonstrated various beneficial activities, including anti-malarial, antimicrobial, antihypertensive, antidiabetic, antioxidant, and anti-inflammatory properties [73].
Combretaceae species find extensive use in traditional medicine to address inflammation, infections, diabetes, malaria, bleeding, diarrhea, and digestive disorders and are employed as diuretics [74].In the Meliaceae family, while various species are utilized for purposes such as vegetable oil, soap-making, and insecticides, Trichilia emetica, a plant native to Africa, holds significance in traditional medicine for treating a range of ailments such as abdominal pains, dermatitis, hemorrhoids, jaundice, and chest pain [75].
As indicated in the current study, the medicinal properties of plants can originate from various plant components such as leaves, roots, bark, fruits, seeds, and flowers.Each plant part may harbor distinct active ingredients, contributing to its therapeutic effects.We found that leaves and roots are the region's most used parts for medicinal purposes.Leaves, often rich in bioactive compounds, are frequently utilized for their therapeutic properties in various remedies and are prepared in various forms ranging from decoctions to poultices.Roots are also valued for their medicinal properties and are often prepared as decoctions or infusions to extract their active ingredients.The range of plant parts used for medicinal purposes and the forms used in the current study reflect the diverse traditional knowledge and practices embedded in local communities across West Africa.
This scoping review, however, highlights the need for broader regional engagement and collaboration on traditional medicines' use to capture diverse perspectives and practices in West Africa, such as conducting more experimental and clinical trial studies to validate Indigenous medicine's use and facilitate their translation into commercial products.This validation is crucial for local healthcare practices, improving access to medical care for populations in the sub-region and scaling up possible management of diseases of concern to the sub-region.
Furthermore, although the current study reports on the landscape of herbal remedies employed for medicinal purposes in West Africa, the findings underscore the need for broader engagement and collaboration to expand the range of studies and countries engaged with trade-medicinal research, given its importance for complimentary healthcare delivery in the region, and the need to address neglected tropical diseases prevalent in the sub-region.Such collaborations will also enrich the diversity of perspectives and practices captured in research and facilitate the commercialization of validated products.
In conclusion, this scoping review mapping the modalities employed in traditional medicine research reveals a rich tapestry of temporal, geographical, and methodological diversity.The findings underscore the enduring relevance of traditional medicine across West Africa and emphasize the need for continued research to harness its full potential for healthcare.The study also highlights the need for further reviews of publications on traditional medicines written in other languages in the region to develop a rich compendium of the opportunities to harness the potential healthcare opportunities traditional medicines offer in the sub-region.
Fig 1 shows the flow diagram of the publication screening process.

Table 1 .
(Continued) NigeriaTo isolate and identify the antimicrobial principles of Acalypha wilkesiana and Acalypha hispida.Experimental study 26 An ethnopharmacological survey of medicinal plants traditionally used for cancer treatment in the Ashanti region, Ghana.Agyare et al., 2018 [39] Ghana To find out how traditional healers in the Ashanti region of Ghana recognize and classify cancer, how they treat the disease with medicinal plants especially in children, and to investigate the collection, identification, preparation, and application of these plants for cancer treatment.Ethnopharmacological survey 27 Herbal Remedies Traditionally Used Against Malaria in Ghana: Bioassay-Guided Fractionation of Microglossa pyrifolia (Asteraceae) Ko ¨hler et al., 2002 [40] Ghana To investigate the antiplasmodial activity of 11 plants from Ghana, where malaria causes many deaths per year, particularly in young children, and to choose 1 of them, Microglossa pyrifolia, for further investigation.

Table 1 .
(Continued) NigeriaTo determine the time course for the induction of antibiotic activity and the effects of different carbon sources, pH, temperature, and bivalent cations on the antibiotic activity of Aspergillus quadrilineatus extracts.Experimental study 37 Evaluation of Efficacy and Safety of a Herbal Medicine Used for the Treatment of Malaria Ankrah et al., 2003 [50] Ghana To determine the efficacy and safety of a decoction, AM-1 was used to treat malaria at an herbal clinic in Ghana.Clinical trial and experimental study 38 Antifungal activities of seven West African Combretaceae used in traditional medicine Baba-Mousa et al., 1999 [51] Benin and Togo To investigate the antifungal properties of 7 species of the Combretaceae family that are abundant in West Africa.Experimental study 39 Antimicrobial activity of the leaves and flowering tops of Acanthospermum hispidum.Fleischer et al., 2002 [52]GhanaTo investigate the antimicrobial activity of the leaves and flowering tops of Acanthospermum hispidum.GhanaThe publication presents the results of a preliminary antimicrobial screening of the methanol extracts of Aframomum melegueta, Piper guineense, Xylopia aethiopica, Zingiber officinale, and medicinal plants of Ghana.

Country Forms in which traditional medicines are used Part of the plant used for traditional medicine Diseases managed by traditional medicines Family of plants used for making traditional medicines
https://doi.org/10.1371/journal.pone.0306594.t002